Method for automating collection of psychotherapy patient information and generating reports and treatment plans

ABSTRACT

The method and apparatus automatedly generates various reports for a psychotherapy provider. These reports include Treatment Plans, progress reports, scheduling reports and billing reports. The progress reports include a Progress Note which incorporates various selected data into a report for the insurance company. As much of the data is selected from menus, the resulting report can maintain much patient privacy while being satisfactory to the insurance company. More private information can be stored separately in Expanded Text. A Treatment Plan is generated using the various selected data with respect to subsets of emotional factors, intellectual factors, physical factors, social factors, and spiritual factors. These subsets may be chosen randomly or with some periodic selection.

BACKGROUND OF THE INVENTION

[0001] This invention relates to the practice of psychotherapy in anenvironment whereby insurance companies and HMOs govern, by theirpayment rules, how patients are cared for. More particularly, thisinvention deals with a method for automating the gathering of patientinformation as well as automating documentation, Treatment Plans, andreports required by insurance companies.

[0002] In the United States, especially in the last eight years with theexplosive growth of managed care and increasingly where Medicare orMedicaid pays for treatment, the administration of psychotherapy isdriven by insurance companies. These companies seek to minimize the costof treatment and demand rigorous documentation by the care provider. Asa result, care providers are forced to spend less time with patients andto spend more time generating documentation. As might be expected,patient care has deteriorated with caregivers increasingly spending moretime, money and energy interacting with managed care companies seekingapproval and providing justification for initial, concurrent and ongoingtreatment.

[0003] Despite time constraints, caregiver is expected to interact witha patient, and to make and record observations about patients and theirbehavior. At some later point, the caregiver must define patientTreatment Plans and generate detailed patient progress reports,typically two pages in length Treatment Plans and status reports arederived from observations made while the caregiver sees patients. It isnot uncommon for a caregiver to see thirty to fifty patients per day.

[0004] Under these trying circumstances, the pressure on caregivers isenormous. The caregivers are attempting to provide a high level ofindividualized care to a multitude of patients in a very short period oftime, yet are expected to provide extensive documentation of theprogress of each patient. Given the circumstances, patients tend to blurtogether making it difficult for the caregiver to remember enough detailabout each patient to adequately report progress and to devise effectiveTreatment Plans.

[0005] All three parties, the patient, the caregiver, and the insurancecompany are badly served by the above situation. The patient receivesless individualized care than he or she requires. The caregiver is underpressure to produce results and documentation in an inadequate period oftime. The insurance agency receives minimal, often generic documentationWhat is needed is a method for easing the caregiver's documentationburden so that he or she might be able to spend more quality, focused,unencumbered time with patients. The insurance company demands forrigorous documentation will not change, thus caregivers must be providedwith a method that will enable them to produce the extensivedocumentation required in less time.

OBJECTS AND SUMMARY OF THE INVENTION

[0006] It is therefore an object of the invention to providepsychotherapy caregivers with an apparatus that will enable them toproduce the detailed documentation demanded of them by insurancecompanies quickly and with little effort.

[0007] It is a further object of the invention that the above apparatusshould be highly portable allowing caregivers to carry the invention topatients.

[0008] It is a further object of the invention to provide caregiverswith an apparatus to generate individualized multiple alternativeTreatment Plans for each patient so that the caregiver might betterdefine an optimal Treatment Plan.

[0009] It is further an object of the invention to construct the aboveapparatus so that it is adaptable to individuals and groups so thatpatients may be tracked through multiple therapeutic environments.

[0010] It is further an object of the invention to share, in appropriatesettings where confidentiality can be protected, information withcolleagues so that patient treatment may be improved and to facilitateteaching of less experienced staff

[0011] It is further an object of the invention to construct the aboveapparatus so complete patient histories, including billing, are compliedin a database as the caregiver uses the invention.

[0012] It is further an object of the invention to format reports insuch a way that patient privacy is protected while report recipients,i.e. insurance companies, receive adequate patient conditiondocumentation.

[0013] These and further objects are attained by a computerized methodand apparatus which automatedly generates various reports for apsychotherapy provider. These reports include Treatment Plans, progressreports, scheduling reports and billing reports. The progress reportsinclude a Progress Note which incorporates various selected data into areport for the insurance company. As much of the data is selected frommenus, the resulting report can maintain much patient privacy whilebeing satisfactory to the insurance company. More private informationcan be stored separately in Expanded Text. A Treatment Plan is generatedusing the various selected data with respect to subsets of emotionalfactors, intellectual factors, physical factors, social factors, andspiritual factors. These subsets may be chosen randomly or with someperiodic selection

[0014]FIG. 1 shows a block diagram of the basic therapeutic process. Afirst step is problem identification. As might be expected, problemidentification is vitally important because a misstep at this point willwaste time and can even lead to an improper Treatment Plan that mightnot benefit the patient or could even harm the patient. Problemidentification is difficult because a patient may have little or no ideaof the real nature of his or her problem(s). It is up to the caregiverto accurately diagnose the true nature of the patient's problem(s)through interaction and observation of the patient and by gatheringinformation from collateral sources.

[0015] A next step is to make an assessment of the identified problem Inassessing the problem, the caregiver win want to define the problem moreconcisely, try to find a precipitating event, and find out what theproblem means to the patient. Throughout the problem identification andassessment steps, the caregiver will record observations about thepatient, typically by taking notes on a computer, by tape recorder,dictation or by hand.

[0016] As shown in FIG. 1, a next step is to make a formal record ofobservations. This usually is performed after seeing a patient, and mayinclude a reexamination of the problem identification and assessmentsteps. At this point, a caregiver must make a decision to continue or toend treatment. If continued treatment is indicated, the caregiver willdefine short-term objectives and long-term treatment goals thenconstruct Treatment Plans to accomplish these goals.

[0017] A final step is Treatment Plan implementation. FIG. 1 shows thetherapeutic process as a closed loop system with problem identificationas the next step after treatment implementation. While this is asimplification, as is the whole of FIG. 1, overall it is an accuraterepresentation of the process.

[0018] After Treatment Plan implementation, the caregiver must decide ifthe Treatment Plan is beneficial and should be continued, or if itshould be modified or abandoned. As shown by FIG. 1, the effectivenessof the Treatment Plan is determined through repeating the process ofFIG. 1.

[0019] The present invention uses portable devices such as laptopcomputers to streamline the caregiver's record keeping throughout theprocess of FIG. 1. Additionally, the invention's Treatment Plangeneration facility acts as a panel of experts aiding the caregiver withexpert advice.

BRIEF DESCRIPTION OF THE DRAWINGS

[0020]FIG. 1 is a flowchart delineating the basic actions of thepsychotherapeutic process.

[0021]FIG. 2 is a block diagram depicting the basic elements of theinvention.

[0022]FIG. 3 is a block diagram detailing elements of the encyclopediaof the invention

[0023]FIG. 4 is a block diagram detailing elements of the invention'shistorical database.

[0024]FIG. 5 is a block diagram showing format groups used with thepresent invention.

[0025]FIG. 6 is a flowchart showing options from the invention's mainmenu.

[0026]FIG. 7 is a flowchart showing the process for generating ProgressNotes.

[0027]FIG. 8 is a flowchart showing the process for generating aTreatment Plan.

[0028]FIG. 9 is a flowchart showing the various processes for schedulingand maintaining groups.

[0029]FIG. 9A shows a flowchart for adjusting group attendance and aflowchart for scheduling group sessions.

[0030]FIG. 9B shows a flowchart for adding or subtracting groupparticipants and a flowchart for group maintenance.

[0031]FIG. 10 is a flowchart showing the process for schedulingindividual patients.

[0032]FIG. 11 is a flowchart showing the process for maintainingindividual patients.

[0033]FIG. 12 is a flowchart showing the caregiver and physicianmaintenance process.

[0034]FIG. 13 is a diagram of the invention as implemented in a networkenvironment.

[0035]FIGS. 14A, 14B, 14C, and 14D show the fields of a Treatment PlanNote with sources of information for populating fields indicated

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

[0036] Before beginning the description of the drawings, it should benoted that the invention, as presently configured, is used with a devicesuch as a computer or a palm corder. The computer includes allconventional components such as memory, storage, a CPU, a display, akeyboard and a mouse. As descried hereinafter, the various selectionsare preferably made b pull-down menus or similar devices as is commonwith WINDOWS® based programs. As envisioned, the caregiver will makerounds then use such devices to generate reports, then dump the reportsinto a central database. Wherever possible, the invention uses pull-downmenus, option boxes, and radio buttons to reduce keyboarding and dataentry time.

[0037] As stated earlier, FIG. 1 shows the psychotherapy process as afeedback loop. Because FIG. 1 is a simplification of the process, itdoes not show the caregiver's constant assessment of the informationreceived directly from the patient or from notes. Nonetheless, thefeedback loop model shown is an accurate reflection of the basicprocesses of psychotherapy whatever the theoretical school. Anexamination of the role of the present invention in the process of FIG.1 aids in an understanding of both the invention and its utility.

[0038] As per the method of the invention, a caregiver will typicallyhave begun a Progress Note, the result of the process of FIG. 7, after asession with the patient. The caregiver selects the patient and entersthe rest of the required bookkeeping data via pull-down menus. Thecaregiver will then move onto the problem identification process 10 asshown in FIG. 1.

[0039] Problems are selected from a pull-down menu of 60 possibleproblems, item 75 as shown in FIG. 3, and Item 1 of the appendix (theappendix delineating a typical problem list). The relatively small sizeof the database required to describe a patient's problems facilitates acompact, fast-running program. Additionally, by providing a concise listof problems, the method and apparatus gives the caregiver a global viewof possible problems without overwhelming him or her.

[0040] Before a caregiver selects a problem, the method and apparatuscan provide a history of patient problems from the Patient ProblemsCross-Reference element item 210 as shown in FIG. 4. This feature ishelpful in the problem identification and assessment stages 10 and 15 asshown in FIG. 1. Conceptually, the role of the method and apparatus isthat of an advisor as opposed to a solution or answer provider. Thepatient history is meant to stimulate the caregiver's own thinking aboutthe patient's problem, not to force caregiver thinking in any singledirection.

[0041] As described previously, assessment 15 as shown in FIG. 1involves direct interaction with, and observation of; the patient.However, the caregiver constantly assesses the validity of his or herobservations, the validity of treatment goals, and the validity ofTreatment Plans, thus assessment is not limited to item 15.

[0042] Patients are not static. Their problems are often in a state offlux, thus treatment objectives and Treatment Plans may be appropriateone day and less relevant the next day. For this reason, the method andapparatus is designed to stimulate caregiver thought processes so thatthe caregiver may better respond to the changing needs of the patient.

[0043] The next step shown in FIG. 1 is recording observations 20. Thecaregiver will typically use the Quick Note format because of timeconstraints. Having entered the problem, the caregiver will thenindicate the problem severity by selecting from a scale of one to fiveon a pull down menu with one being least severe and five being mostsevere. Next the caregiver will select from an Other Related Conditionspull down menu This information comes from item 165 as shown in FIG. 3and is keyed to the cited problem, and describes situations that aretypically related to the problem. Because of the linkage to the problem,those conditions that are relevant to the problem will appear first inthe pull down menu.

[0044] The caregiver will then select a focus of diagnosis from a pulldown menu. This information comes from item 135 as shown in FIG. 3 andis not keyed to the problem. The focus of diagnosis simply defines thetype of interaction with the patient. Typically, these might be anintake interview, a reassessment after hospitalization, orpsychoanalytically informed treatments.

[0045] The caregiver will then select a behavioral definition from apull-down menu. The behavioral definition is a global description of thepatient's condition and comes from the treatment encyclopedia data block100 as shown in FIG. 3. Behavioral definitions are keyed to problems;thus the pull-down menu first displays those behavioral definitions thatare relevant to the problem. The behavioral definitions in the treatmentencyclopedia are culled from medical literature and will be readilyaccepted and understood by those reviewing the Progress Note.

[0046] Next, the caregiver will select an emotional issue which thecaregiver deems is a relevant stimulus or precipitant to the problem(s)being addressed in that session from the treatment encyclopedia datablock 160 as shown in FIG. 3. The emotional issue is also selected froma pull-down menu, but it is not keyed to the problem. Like thebehavioral definitions, the emotional issue section of the treatmentencyclopedia was collected from medical literature. The caregiver willthen select a physical issue, if relevant from a pull-down menu.Physical issues, i.e., medical problems or conditions, are not keyed toany particular problem and come from the physical issues part of thetreatment encyclopedia 140 as shown in FIG. 3. Physical issues areclassified by ICD-9 codes.

[0047] Next, the caregiver selects a coping mechanism, which is thepatient's defensive or adaptive style. Again, this item is selected froma pull-down menu. Coping mechanisms come from the treatment encyclopedia155 as shown in FIG. 3, and are not keyed to the problem Finally, thecaregiver will select patient responses from 170 as shown in FIG. 3 andselect an immediate future treatment(s) from 150 as shown in FIG. 3.Both the patient response and future treatment are selected frompull-down menus and are not keyed to a particular problem.

[0048] Taken alone, the problem, the problem severity, behavioraldefinition, emotional issue, physical issue, focus of diagnosis, otherrelated conditions, coping mechanism, patient response, and suggestedfuture treatment might seem generic, something like medical boilerplate.However, when viewed as a group in totality, these selected items give acomplete picture of the patient's condition and progress whileprotecting the patient's right to privacy. Through this means, thecaregiver can give an insurance company or government agency gooddocumentation without betraying any confidences that are so crucial tothe caregiver-patient relationship.

[0049] To finish the Progress Note, the caregiver has the option ofentering a brief note via the keyboard or by a speech recognition chipin a palm corder type device. This note, called Expanded Text in themethod of the invention, allows the caregiver to makes specific commentsabout sensitive but important data about the patient. This data isstored separately in the historical record section, item 250 as shown inFIG. 4. Access to this information is restricted to the patient'scaregiver or to other caregivers. Outside agencies do not have access tothis material, and to further protect the patient's privacy, thismaterial can be redacted.

[0050] The caregiver may, particularly after an initial session, enterformal diagnostic psychological and medical information using the FormalProgress Note 410 as shown in FIG. 7. This is done via a pull down listof DSM-IV and ICD-9 codes. Specific medical problems, procedures, orhospitalizations may be recorded by selecting the relevant code andentering starting and ending dates. Similarly, medications may betracked and updated as necessary using these codes.

[0051] The generic information described earlier provides excellentdocumentation for outside agencies while protecting them from theliability of inappropriate release of confidential patient information.Caregivers, on the other hand, need the highly personal information fromthe Expanded Text to aid them in their search for clues to patientbehavior.

[0052] The time required to complete the short form Progress Note isbrief. The caregiver need only select nine items from pull down menusand type or dictate a brief comment to fully document the session withthe patient and present a thorough report on the patient's condition.These items, (1) problem, (2) severity, (3) focus of diagnosis, (4)other related conditions, (5) behavioral definitions, (6) emotionalissues, (7) physical issues, (8) patient response, and (9) futuretreatment are all accessed via pull-down menus. Given experience withthe method and apparatus, a caregiver should be able to complete theprocess in three to five minutes. The resulting short form Progress Notebecomes part of the patient's history and is stored in that data block195 as shown in FIG. 4, except for the Expanded Text which is stored inthe Progress Notes Expanded Text block 250 as shown in FIG. 4.

[0053] After completing the Progress Note, the caregiver would likelymove on to formulating a Treatment Plan, which may be done manually orautomatically. A Treatment Plan includes advice of a future orprospective nature for the caregiver. However first a decision must bemade to continue or end treatment, items 35 and 30 as shown in FIG. 1respectively. Most of the time, continuation is the obvious action totake, but with the pressure on funds for treatment, caregivers may beforced to spend their time with those who would benefit most fromtreatment. The caregiver may consult the Progress Note patient history195 as shown in FIG. 4 as an aid in making this decision.

[0054] If a decision is made to continue treatment, the caregiver needsto define objectives and goals. At this point, the caregiver mightreview behavioral definitions, short term objective, therapeuticintervention and assessment reference files from the treatmentencyclopedia. Alternatively, the caregiver may opt to instruct themethod and apparatus to automatically generate the Treatment Plan(process described below) which is then combined with the “live” datapreviously entered by the caretaker, resulting in the “Treatment PlanNote.” With the aid of this information and the Treatment Plan optionsgenerated by the method and apparatus as shown in FIG. 8, the caregiverwill define a Treatment Plan 40 as shown in FIG. 1 that best fits thepresent needs of the patient.

[0055] In item 45 as shown in FIG. 1, the caregiver implements thetherapeutic intervention defined in the Treatment Plan of item 40. Asshown by FIG. 1, the therapeutic process begins again after thetherapeutic intervention. The patient's reaction or lack of reaction tothe intervention is assessed and acted upon by the caregiver through theprocess of FIG. 1, thus completing the feedback loop.

[0056] Throughout the process of FIG. 1, the method and apparatus haveaided the caregiver by greatly speeding up the documentation process.Instead of the burdensome, oftentimes redundant, and time consumingprocess of filling out forms by hand or from a keyboard, the caregiverneed only select options from pull-down menus. Additionally, thecaregiver need no longer rack his or her mind for descriptive terms andlanguage and treatment ideas. The pull-down menus and Treatment Plansgenerated by the method and apparatus provide caregivers withstimulation, structure, and alternatives.

[0057]FIG. 2 shows the basic data blocks that are used by the method andapparatus of the present invention. The treatment encyclopedia 50contains information used for reference and for formulating TreatmentPlans. The information in the treatment encyclopedia comes from acceptedmedical literature and professional experience. The contents of thetreatment encyclopedia are described more fully in the discussion ofFIG. 3.

[0058] Item 55 contains historical data. The various data sub-groups aredescribed in detail with the discussion of FIG. 4, but generally, item55 is the record of the method and apparatus of the invention. Thehistoric database is added to constantly by the method of the invention.Any new data such as Progress Notes, new patients, new caregivers,updated personal or insurance information, collateral information orcontacts or billing records become part of the data of item 55. Throughaccessing the data of item 55, a caregiver can pull up a completehistory of a patient or groups of patients with complete records ofProgress Notes and Treatment Plans and billing records.

[0059] Item 60 contains the algorithms used to formulate Treatment Plansas well as those algorithms specific to the method and apparatus of theinvention that enable interaction between the various screens andgeneration of reports. Item 65 contains the data required to formatscreens and reports. The various sub-groups of item 65 are described indetail with the discussion of FIG. 5.

[0060] The data blocks of FIG. 2 are divided by function and as such arenot dependent on any particular operating system. However, all the datablocks described are needed for the method and apparatus of theinvention to provide the functional aspects of data gathering, reportgeneration, and Treatment Plan generation described in thisspecification.

[0061]FIG. 3 shows the details of the treatment encyclopedia. This datablock is the primary reference for the method and apparatus of theinvention. Item 70, the problem block, contains two sub groups, 75 thehas of 60 problems shown as Item One in the appendix, and a Diagnosticand Statistical Manual cross reference 80. Problem list 75 describes theproblems displayed by patients in the majority of cases. The problemsare denoted with specific code numbers. As an example amnesia has a codeof 100, anger has a code of 200, and anxiety has a code of 500. Item 80,the DSM cross reference, defines the problems of item 75 in standardDSM-IV codes so outside agencies such as insurance companies will findthe problems listed in item 75 acceptable.

[0062] Assessment data block 85, long term goal data block 125, shortterm objectives block 120 and therapeutic interventions block 130 aredivided into sub groups consisting of emotional factors, intellectualfactors, physical factors, social factors, and spiritual factors. Thesefive factors along with problem list 75 serve to clarify and simplifythe description of the bewildering number of conditions displayed bypatients. The aforementioned five factors encompass all areas that caneffect patients and must be allowed for when dealing with the patient.By defining assessment data, short term objectives, long term goals, andtherapeutic interventions in terms of these factors, the method andapparatus of the invention gives caregivers a vocabulary to define apatient's condition and treatment options concisely using easy-to-usepull-down menus thus greatly simplifying the caregiver's work.

[0063] These data blocks are keyed to the problem data block 75. Thus,when a caregiver accesses these data blocks, those factors keyed to theproblem being examined appear first in the pull-down menus. Thisprioritizing of factors serves to focus the caregiver and prevents himor her from being overwhelmed by data.

[0064] Assessment step 15 as shown in FIG. 1 is essentially a refinementand focusing of problem diagnosis step 10 as shown in FIG. 1. Throughthe assessment process, the caregiver attempts to define the exactnature of the problem and its intensity. Data block 95 as shown in FIG.3 provides the caregiver with a vocabulary for assessment in the fivedimensions, emotional, intellectual, physical, social and spiritual.Data block 95 has been modified and refined so that it reflects anaccurate assessment of a patient in the great majority of cases. Goingwith the philosophy of the invention as an advisor and aid to thecaregiver, the invention suggests possibilities, but the caregiver hasthe final word in defining the nature of the patient's problems.

[0065] Assessment criteria are also important in the scheme of theinvention because they factor in the Treatment Plan generationoperation. When the caregiver generates a Treatment Plan FIG. 8, thebasic process is as follows. The invention creates Treatment Plansthrough the presentation of behavioral definitions from block 110 asshown in FIG. 3, assessment data from block 95 as shown in FIG. 3,short-term objectives from block 123 as shown in FIG. 3, therapeuticinterventions from block 127 as shown in FIG. 3, and long term goalsfrom block 133 as shown in FIG. 3. These elements are keyed to theproblem code. Thus, if the problem code is anger item 200 in the problemlist in the appendix, those elements of data blocks that refer to angerare selected as possibilities. The cross reference blocks for assessment95, short term objectives 123, long term goals 133, and therapeuticinterventions 127 refer to five dimensions of a patient's condition. Thefive dimensions are physical, emotional intellectual, social andspiritual.

[0066] As an example, short term objectives 120 as shown in FIG. 3 hastwo elements, the cross reference section 123 and the Max section 105.The cross reference section links the short term objectives data blockto problems data block 70 in five different dimensions, physical,intellectual emotional, social and spiritual. Thus when a Treatment Planis created, the short term objectives section will have problem focusedinformation for all five dimensions.

[0067] The Max section 105 defines limits for the randomizing algorithmused in creation of Treatment Plans. Datablocks 85, 100, 125, and 130also have Max elements in them. The Max elements are statisticallistings of the incidence of particular aspects in those datablocks.These values were defined originally when setting up the program. Maxshave been altered over the life of the program as a database of patienthistories has developed. As per the method of the invention, Maxs serveto inform the algorithm used in formulating Treatment Plans as to theextent of the possible information selections linked to any one problem.Thus the problem of anger may thirty informational selections associatedwith it, while different problems will have more or less informationselections. The Max informs the Treatment Plan algorithm about theextent of the information pool.

[0068] Datablocks physical issues 140, emotional issues 160, severity163, coping mechanisms 155, patient responses 170, and other relatedconditions 165, focus of diagnosis 135, and future treatments 150, allof FIG. 3, provide additional information to the caregiver and areavailable to the caregiver at anytime. There is, of course, someoverlap. For example, many physical issues, emotional issues, copingmechanisms and patient responses are common to those having problemswith anger and those having problems with anxiety.

[0069] To generate the Treatment Plan, the device, via the relationaldatabase program, takes text and “boiler-plate” relating to variousfields from a master table of “Treatment Plan-Additional Text” 233 FIG.4 and merges the input entered by the user (including input data chosenfrom the menus), as selected by the randomizing or similar routine,therewith.

[0070] The information presented to the caregiver both serves to slatethe caregiver into thinking along appropriate lines and prevents thecaregiver from being overwhelmed by possibilities. This last aspect iscritical because the problems presented by patients are complex, withsevere time constraints and intense interactions with colleagues intreatment teams serving to complicate matters even further. Takentogether, these factors can leave a caregiver feeling blocked andoverwhelmed. By presenting a constrained listing of information to thecaregiver, the invention helps the caregiver to focus and clarifiesissues concerning diagnosis and selection of Treatment Plans.

[0071] In other words, the current or historical data is entered by thecaregiver and combined with prospective advisory data (as retrieved fromthe treatment encyclopedia as indexed by the randomizing or similarfunction) to generate a Treatment Plan Note is the most comprehensiveand useful end result.

[0072] Moreover, particularly with regard to the Treatment Plan, thedevice may be implemented as using artificial intelligence using thetables and mechanisms described above. In particular, the “severity”function can be used to delimit the data available to the randomizing(or similar selection) algorithms in the generation of the TreatmentPlans Further, an internal feedback looping process can be used toenhance the functionality and usefulness of this method and apparatus inclinical settings. With the addition on an “outcome” button (withassociated underlying mechanisms and elements, such as the master tableof outcomes for the Treatment Plan Note, queries, forms, reports, etc.)on the Quick Entry Screen for individual Progress Notes and the Adjust“Group” Attendance/Participation screens, the caregiver can providefeedback to the method and apparatus in the form of; firstly, results(in quantifiable and analyzable form) of the therapeutic inventionsutilized and, secondly, the specific inventions utilized in the priorindividual or group session.

[0073] By a system of tracking, quantifying and analyzing these resultsand methods (that is, therapeutic interventions and future treatments),the method and apparatus of the invention, with artificial intelligenceimplemented, can, in effect, monitor itself and by accurately recordingthe entered data and computer generated Treatment Plan Note, “learn” viaartificial intelligence, which particular strategies (that is,therapeutic interventions, future treatments) can best addressparticular “problems of the day” short term objectives and long termgoals.

[0074]FIG. 4 shows the elements of the invention's historical database.These data blocks are keyed to individual patients so that the historyof each patient can be defined in the context of these elements. Thisdatabase evolves with use. Most of the elements require little in theway of explanation.

[0075] The patient master table 240 contains information about thepatient such as the name, sex, birth date, social security number aswell as the patient's Medicare and Medicaid numbers. The key element isthe social security number because every patient must have a uniquesocial security number. Billing history 175 is simply the completehistorical record of each patient's billing history. Caregiver's canaccess the complete record, the billing history for any given timeperiod, or the most recent billing. Billing histories may be accessedvia the main menu screen, patient look up screens, or from Progress Notescreens.

[0076] The physician record element 180 is the historical record ofpatient medical doctors other than the caregiver. Typically a patientwould have a medical doctor addressing physical problems while themental health caregiver supervises patient mental and emotionalproblems. With an aging population, many of a patient's physicalproblems will have a profound impact on the patient's mental state andvice versa. Thus, the caregiver and physician need work closely. Becausepatients may have multiple physicians or may change physicians, thecaregiver must have access, whenever feasible, to the complete historicphysician record to obtain all patient data including but not limited tohospital, rehab and medication information.

[0077] The caregiver record 200 is similar to the physician record inthat a patient may have dealings with different caregivers. It may beimportant for the present caregiver to speak with the caregiver of aprevious time so that the caregiver can define a patient's history interms outside his or her own experience. Patients, particularly innursing homes, retirement communities, or residential care facilitiesmay have required treatment over the course of several years. It isimportant for a new caregiver to understand the experience of previouscaregivers thus the need for the historical record of caregivers.Additionally, the caregiver record has links to billing histories thusallowing analysis of caregiver productivity.

[0078] Facility record 220 and service location record 235 are simplythe historic records of locations where patients are treated and thelocation of the caregiver's office respectively. The facility recordcomes into play when the caregiver uses the patient look up screen. Thecaregiver first selects the facility from then selects the patient fromthe record of those patients at the facility. The patient master table240 contains those records that define the patient such as sex, birthdate, Medicare and Medicaid number and social security number. When thecaregiver chooses the patient, those information fields are filled inautomatically from this table. Facility and patient selection use dropdown menus and are rapid and effective way of identifying the patient.The service location record comes into play when defining caregiverbilling records.

[0079] The patient physical issues cross reference 190 is the historicalrecord of patient physical problems. Because physical issues candirectly influence a patient's mental state, caregiver's must haveaccess to a complete history of the physical issues confronting thepatient. Patient problems cross reference 210 contains the history ofpatient problems recorded from Progress Notes.

[0080] The Progress Notes section 195 is the historical record ofProgress Notes written throughout the course of the patient's treatment.This database contains Progress Notes made by all caregivers not justthe current caregiver. This accumulated collection of notes provides animportant record of the course of a patient's condition and reaction totherapy. The caregiver's ready access to this material throughout theprocess of the invention enables more informed problem selection andassessment as well as an examination of the progress of the patient'smental state through the course of treatment.

[0081] As described earlier, the Progress Notes Expanded Text section250 as shown in FIG. 4 is that part of a Progress Note where a caregiverhas entered a personal observation and DSMIV diagnosis focused on theproblem of the day. This section is linked to the Progress Notessection, but is kept as a separate database so that a caregiver need notfear accidentally making this information available to an outsideagency.

[0082] Progress Notes Additional Text 245 and Treatment Plan AdditionalText 233 contain phrases that are used in conjunction with elements fromthe treatment encyclopedia and data from Progress Notes to fill outfields in reports. This will be explained in detail with the discussionof FIGS. 14A, 14B, 14C, and 14D.

[0083] The various group histories, group master 185, group participants205, group session master 225, and group session participant ProgressNotes 215 are used for scheduling and for tracking a patient's progressthrough the group therapy environment. The caregiver needs to be able toexamine these historical records in detail to understand the patient'sbehavior more thoroughly because patient's often react differently in agroup environment than they do one-on-one with the caregiver.

[0084] To better understand the patient's reaction to these differingenvironments, the caregiver must know the participants in each group. Itis possible that a patient reacts badly to a certain individual or acertain type of behavior displayed by other individuals. A patient mightbe outgoing and vocal in a sheltered setting, but may be withdrawn oraggressive in the more stressful group environment. Unless the caregiverhas access to detailed histories of a patient's group participation, heor she will be unable to understand and treat the fill range of thepatient's problems in the context of their known strengths andabilities.

[0085]FIG. 5 shows the collection of formats used by the invention todefine screen layout and interaction with other elements of theinvention. All formats are designed so that the caregiver can move fromscreen to screen as quickly as possible and to minimize caregiver dataentry chores. Drop-down menus are used wherever possible, i.e. forpatient selection or for reference and review of histories.Additionally, formats such as Progress Notes are designed with as much“boilerplate” as possible so that caregivers need only fill in theblanks to give a complete and accurate description of a patient'scondition

[0086] The Progress Note formats 255 FIG. 5 and Progress NotesAdditional Text 245 FIG. 4 are designed to work in concert to minimizecaregiver data entry. The Progress Note format section 255 defines theoverall structure of the Progress Note with the Progress Note AdditionalText section 245 serving to provide the boilerplate language for theQuick Note and the four page Formal Progress Note input screens andreports. As in descriptions of other data block sections of theinvention, the actual formatting structures are dependent on the chosenoperating system, thus this specification will include a genericdescription of those data blocks needed to implement the invention.

[0087] Assessment reference format 280, short term objective referenceformat 290, and therapeutic intervention reference format 285 aredesigned to present those elements in five dimensions: emotional,intellectual, physical, social and spiritual, cross referenced to theproblem being worked on. As presently configured, the invention presentsthis information in a pull-down menu format so that the caregiver maybrowse through the possible selections easily and make selections by asingle action such as a mouse click.

[0088] The Treatment Plan format 260 defines the Treatment Plan screenlayout and also defines the linkages of the Treatment Plan screen toother parts of the invention. The Treatment Plan by Date format 265defines screen layout and links so that the caregiver can call up thehistoric record of Treatment Plans and access any time period desired.Patient history format 270 and billing history format 275 are similar tothe Treatment Plan by Date format in that these formats are designed tolet the caregiver access a patient's history and billing history for anytime period quickly and easily.

[0089]FIG. 6 is a block diagram of the options available to caregiversfrom the main menu screen of the invention. From the main menu screen295, the caregiver has four options, enter data 300, generate reports302, transfer files 305, and examine reference files 310. The Enter Dataoption 300 is the take off point for most of the caregiver's work. Fromthis option, the caregiver deals with individual patients 315, workswith groups 320, schedules patient therapy sessions 325, and updatesphysician or caregiver information 330.

[0090] The Generate Reports option 302 allows the caregiver to generatereports such as a semi-annual review of a patient's problems 316, listsof patients seen by a caregiver over a specific time period 322, and areview of patient intakes over a given time period 326.

[0091] The Transfer Files option 305 allows caregivers to transfer filesfrom one device to another. Typically, a caregiver would use this optionwhen downloading work done on a laptop or a palm corder to a network atthe end of a shift. Another typical use is accessing and downloadingrecords from a network server to a caregiver's laptop. The transferfiles option is not only a convenience, but is necessary for historicaldatabase compilation purposes. As mentioned previously, caregivers needcomplete access to patient histories. The file transfer option enablesautomatic construction of the patient histories through downloading ofprogress reports and other current records.

[0092] The Examine Reference Files option 310 allows caregivers to movedirectly to Assessment Reference Files 335, Short Term ObjectiveReference Files 340, and Therapeutic Intervention Reference Files 345.Typically, a caregiver might access these files to gain insight about aparticular behavior or problem displayed by a patient. As mentionedpreviously, these datablocks are referenced to particular problems andare defined in five aspects, emotional, intellectual, physical, social,and spiritual. Thus, for nearly any type of problem, a caregiver canquickly pull up and examine a compilation of assessment criteria, shortterm goals and therapeutic interventions keyed specifically to thatproblem. The value of this rapid access to complete information cannotbe overstated given the time constraints faced by caregivers. In thosesituations where the caregiver is blocked and needs stimulation or wherethe caregiver needs to verify an assumption, this aspect of theinvention is invaluable.

[0093]FIG. 7 shows the process of the Progress Note. As mentionedpreviously, there are two Progress Note forms, the Quick Note and theFormal Progress Note. The Quick Note is the standard caregiver workingnote. This form of Progress Note contains sufficient data to be anexcellent source of information for the caregiver and other caregiverswho might treat the patient. The Formal Progress Note provides moredetailed documentation and is meant for use by outside agencies such asinsurance companies, or for detailed record keeping in medical hospitalor clinical settings. Additionally, the formal note might be used forresearch or educational purposes. The format of the Formal Progress Notecombines readily accepted medical boilerplate with “fill-in-the-blank”information from pull-down menus to define a patient's status andprogress in a manner that will be complete and useful to outsideagencies and for internal record keeping.

[0094]FIG. 7 describes the process for both types of notes, thedifference in the two being primarily length, type of boilerplate, andresulting pull-down menus used for the two. The caregiver begins fromthe main menu screen 295 and moves from there to the select patientlook-up option 355. The caregiver selects the facility from a pull-downmenu 360, then selects the patient from a pull-down menu showing thepatients at the facility 365.

[0095] In item 370, the caregiver selects the Progress Notes option,then selects a problem of the day. In most cases, the caregiver willhave already determined the problem when interacting with the patient.Nonetheless, the caregiver may want to review a history of the patient'sproblems to get a historic perspective on the patient's progress. Item375 indicates the option to review the patient's historical problems 380or to move straight to problem selection 385.

[0096] At this point, the caregiver must decide whether to proceed tothe Quick Note 395 or the Formal Progress Note 390. After the caregiverchooses the desired format, the process is basically the same for bothformats. With the quick form, the caregiver enters data 395 usingpull-down menus for various “f-in-the-blank” questions and might enter amore personal observation in the expanded notes section. Typically, thecaregiver would first indicate problem severity, select other relatedconditions, and focus of diagnosis, and then select a behavioraldefinition(s). As previously described, Behavioral Definitions, item 100as shown in FIG. 3, are global descriptions of a behavior and are keyedto selected problems. Thus, those behavioral definitions keyed to theproblem selected at item 385 will appear first in the pull-down menu.

[0097] Next, the caregiver would select a relevant emotional issue froma pull-down menu originating from data block 160 as shown in FIG. 3.Emotional issues are not linked to any particular problem because aproblem may or may not be a direct manifestation of an emotional issue.However, emotional issues and precipitating events that lead toemotional issues, are important clues to a patient's behavior thusshould be included in a Progress Note. Next, the caregiver might selecta physical issue from a pull-down menu. The physical issue dataoriginates from the Physical Issues datablock 140 as shown in FIG. 3. Sothat the physical issue data is universally acceptable, physical issuesare expressed in terms of standard ICD-9 definitions and codes. Forconvenience, colloquial descriptions are used as well, i.e. arthritic,diabetic, and/or cardiac conditions. As with emotional issues, physicalissues are not linked to any particular problem. A patient problem mayor may not be a direct manifestation of a physical issue. However, aswith emotional issues, physical issues are vital to an understanding ofa patient's behavior.

[0098] The caregiver might then select a coping mechanism, (adaptivestyle), displayed by the patient from a pull down menu. This informationoriginates in data block 155 as shown in FIG. 3, and is not keyed to theproblem selected at item 385. As with the emotional and physical issuesselection, a patient's coping mechanism can be an important clue to apatient's progress, yet may or may not be a direct manifestation of theproblem selected at 385.

[0099] At this point the care giver might select a patient response totreatment and a possible future treatment. Both items are selected frompull-down menus and originate from items 170 and 150 as shown in FIG. 3respectively. Again, neither item is linked to the problem of 385 yetboth items are important records for the therapy process.

[0100] The items just described, problem severity, focus of diagnosis,other related conditions, behavioral definitions, emotional issues,physical issues, coping mechanism, patient responses, and suggestedfuture treatments are all options available in the Quick Note. Takentogether these items form an effective snapshot of the patient at thetime of the evaluation. If these items are combined with a caregiverpersonal observation in the Expanded Note section of the Quick Note, theresulting record is &detailed description of the patient that becomes aninvaluable reference for the caregiver and any other caregiversentrusted with the care of that particular patient. With very littlepractice, the caregiver will be able to create this precise record in amatter of three to five minutes.

[0101] After completing the Progress Note 395, the next step is todecide whether or not to print the report 415. If printing is desired,the caregiver selects the Print Report option 420. If not, the caregivermoves directly to the decision to select another patient 425.

[0102] If the caregiver decides to continue with another patient, theprocess loops back to the Select Facility option 360. If the caregiverchooses to end the Progress Note process, he or she returns to the mainmenu 295 for other options such as patient scheduling 325 as shown inFIG. 6.

[0103] If at decision point 390, the caregiver had chosen to select aFormal Progress Note, the process is exactly the same except that theformat of the formal note is more detailed and contains a lengthysection on assessment data, short term objectives, long term goals, andtherapeutic interventions. Because the assessment data, short termobjectives, and therapeutic interventions are keyed to the problem,those assessment criteria related to the problem appear first in thepull-down menus.

[0104] As described earlier, the assessment data originate from datablock 85 as shown in FIG. 3, and are expressed in five dimensions,emotional, intellectual, physical, social and spiritual. The FormalProgress Note allows the caregiver to make selections in all five areas.The Formal Progress Note also permits selections in all five areas forshort term objectives and therapeutic interventions. As with the asses tdata section, short term objectives and therapeutic interventions arekeyed to the selected problem. If the selected problem were anger, thecaregiver would have the opportunity to select comments about assessmentdata, short-term objectives, and therapeutic interventions in all fiveareas for anger (physical, emotional, intellectual, social andspiritual).

[0105] After completion of the Formal Progress Note, the caregiver movesthrough the process as described earlier. Decisions are made concerningprinting the report 415 or selecting another patient 425. Thus, otherthan differences in report length, the Formal Progress Note processmirrors the Quick Note process.

[0106] The Treatment Plan process of FIG. 8 is a vital component of thetherapeutic loop of FIG. 1. With the creation of the Progress Note, thecaregiver has defined the patient's current state. With the TreatmentPlan, the caregiver defines the nature of hoped for patient improvementand a suggested method for achieving progress.

[0107] In going with the philosophy of the invention as an advisorrather than a solution provider, the process of FIG. 8 providessuggested Treatment Plans for the caregiver to review. The caregiver isnot expected to take Treatment Plan suggestions as instructions to befollowed exactly. Instead, the caregiver uses the suggested TreatmentPlans as a stimulus to define an optimal treatment program. In theprocess of FIG. 8, the caregiver may look at several alternativeTreatment Plan suggestions before deciding on a course of action.

[0108] The process of the invention for generating Treatment Plansinvolves selecting assessment data, short term goals, therapeuticinterventions and long term goals keyed to problems defined in ProgressNote reports. If, as would be typical, the caregiver generates theTreatment Plan in concert with a Progress Note, the problem so definedwould be the focus of the Treatment Plan, and the result of the processdefined as a Treatment Plan Note. If the caregiver decides to skip theTreatment Plan step, the invention automatically generates a TreatmentPlan for any Progress Note that does not have an attendant TreatmentPlan when the caregiver next accesses the Treatment Plan option.

[0109] Additionally, the invention will generate a Treatment Plan foreach of the problems associated with the patient defined in a ProgressNote. Thus, if the caregiver identified anger and depression as problemsfor a given session, the invention would generate one Treatment Plan foranger and one for depression for that given therapy session.

[0110] Treatment Plan generation begins when the caregiver selects theTreatment Plan option from the main menu screen 435 as shown in FIG. 8.The next step in FIG. 8 is to select the problem that is to be the focusof the Treatment Plan 440. If the caregiver is operating out of the mainmenu after completing a group of Progress Notes, the inventionautomatically defaults to the problem already selected in the ProgressNote for that given session. With items 445, 450, 455, and 460, theinvention retrieves assessment data, short term objectives, therapeuticinterventions, and long term goals that are keyed to the selectedproblem. This collection of data is gathered from data blocks 85, 120,130, and 125 respectively, all from the therapeutic encyclopedia of FIG.3.

[0111] As previously described, assessment data, short term objectives,therapeutic interventions, and long term goals are defined in emotional,intellectual, physical social and spiritual terms. As presentlyconfigured, a randomizing algorithm 465 as shown in FIG. 8 selects twoitems from each of the five factors from items 445, 450, and 455 thenselects two factors from 460. The invention then displays that result asTreatment Plan options 470. Alternatively, the randomizing algorithmcould be replaced with systematic, periodic or manual selection of asubset of emotional intellectual, physical, social and spiritual terms.

[0112] After reviewing the treatment options offered in item 470, thecaregiver must decide if the options are acceptable 475. At this pointthe caregiver has three choices. The options may be deemed acceptable,the caregiver may selectively edit out irrelevant or inappropriatematerial or the caregiver may opt to define an entirely new TreatmentPlan by cycling through the randomization algorithm again. If thecaregiver decides to edit the plan, he or she will optimize theTreatment Plan then save it 485 and return to the main menu screen 295.If the caregiver has decided to opt for a new Treatment Plan, theprocess loops around to item 445.

[0113] Experience has shown the process of FIG. 8 to be an effectivemethod for generating Treatment Plan Notes. All options presented in 470are keyed to the problem thus are relevant. Additionally, patientproblems are complex and there is never one correct Treatment Plan. Manytreatment approaches are valid and caregivers have found the manyoptions suggested by the process of FIG. 8 to be helpful in defining anoptimum Treatment Plan for patients. Additionally, patients are notstatic. Their problems can change dramatically from day to day, and thelimitless number of Treatment Plan options offered by the invention canaid caregivers in their attempts to stay abreast of changing patientconditions and anticipated events or reactions to treatment.

[0114] As a refinement of the invention, a severity factor has beenincorporated into the invention as a problem modifier . When a caregiverselects a problem for a Progress Note, he or she indicates the severityof the problem on a scale of one to five. This has the effect ofweighting the linkages between a problem and the items selected forTreatment Plan generation. As a result of this process, the range ofitems selected during the process of 445, 450, 455, and 460 is narrowedand are more closely aligned to the patient profile. This is not to saythat the philosophy of the invention has changed. The options presentedin item 470 should be only regarded as suggested options. It is up tothe caregiver to decide on the course of treatment. However, thenarrowed spectrum of possibilities allows the invention to present amore tightly focused group of options to the caregiver.

[0115]FIG. 9 details the courses open to caregivers when choosing fromthe groups option 320 as shown in FIG. 3. From the main menu screen 295as shown in FIG. 9, caregivers can select from the group maintenanceoption 520, the add group participants option 510, the schedule groupsessions/group Progress Notes option 505, or the adjust group attendanceoption 500. Taken together, these four options provide al the toolsneeded for caregivers to create, maintain and schedule therapy groups.

[0116] The group maintenance option 520 is used to set up anddecommission groups. With option 520, the structure of the group is setup. The group is populated with patients using option 510, add groupparticipants. The caregiver begins the process of option 520 byselecting the chosen facility from a pull down menu 525 as shown in FIG.9B. The caregiver names the group entering the name in the data entryscreen 530 FIG. 9B, then decides if another group is to be entered 535FIG. 9B. If so, the process loops around to the select facility option525. If the caregiver wishes to exit the process of 520, he or sheselects to return to the main menu 540 FIG. 9B.

[0117] At this point, the caregiver would populate the group justcreated using the add group participants option 510 FIG. 9B. Thecaregiver begins this process by selecting a facility and the group namefrom pull-down menus 545 as shown in FIG. 9B, then selects the name ofthe group participant by selecting a facility and patient name frompull-down menus 550 as shown in FIG. 9B. The reason the facility must beselected a second time is that patients from one location may take partin groups at another location.

[0118] The caregiver then moves on to the add or delete option 555 asshown in FIG. 9B. Since the process of 510 is used both to add anddelete patients from groups, the caregiver must indicate his or herintention on the screen of item 555. At this point, the caregiverindicates if another patient is to be added or deleted from a group. Ifthe caregiver wants to continue the process of 510, there are twooptions. The caregiver can continue to work with the present group bymoving to the select patient option 550. If work with a different groupis desired, the caregiver moves to the select facility and group option545. If the caregiver wishes to exit the process of 510, he or shereturns to the main menu 565 as shown in FIG. 9B.

[0119] After populating a group with patients, the caregiver moves on tothe process scheduling the group by selecting option 505 as shown inFIG. 9A. Option 505 serves a double duty as it is used to set groupschedules and as an entry to the Group Progress Note option. The processof 505 as shown in FIG. 9A begins with the caregiver selecting thefacility 570 as shown in FIG. 9A and the group 575 through the use ofpull down menus. At this point 580 as shown in FIG. 9A, the caregiverindicates whether the objective is to start a Group Progress Note byselecting the Group Progress Note option 585 or to move to thescheduling option 590.

[0120] If the caregiver chooses the scheduling option, he or she entersa starting time and date and the invention automatically schedules apreset number of group meetings at that time slot. With item 595, thecaregiver indicates whether another group is to be scheduled, in whichcase the invention loops back to item 570. If the other option isselected at 595, the caregiver goes back to the main menu 600.

[0121] The process of the Group Progress Note 585 is slightly differentfrom an individual Progress Note. The dynamics of a group's interactionare complex compared to reactions of individuals within the group. Thus,data entry 588 consists of the caregiver moving directly to an expandednote section where the behavior of the group, (including process notesand therapeutic group issues), as well as significant individual patientreactions are noted.

[0122] When the note is saved 592, it automatically is placed in therecord of all patients who are scheduled to participate in a group.Typically, a caregiver then returns to the main menu 600 to recordindividual Progress Notes for all members of the group through selectionof adjust group attendance option 500 as shown in FIG. 9. Thus, apatient record will contain the Group Progress Note delineating thedynamics of the group and the group's reaction to the group discussionin an individual Progress Note detailing the patient's reaction to thedynamics of the group and his or her progress in dealing with specificproblems within the context of the group therapeutic experience. Thisinformation is contained in a second Expanded Text section. Thus theProgress Note for a patient attending a group will have the generalExpanded Text note common to all who attended the group and anindividualized Progress Note focusing on the patient. The invention isstructured so that the group expanded note is saved then automaticallyadded to each individual Progress Note as the caregiver writes the note.

[0123] The adjust group attendance option 500 as shown in FIG. 9A isaccessed from the main menu. After selecting option 500, the caregiverwill select the facility and the group from pull-down menus 605. Next,the caregiver selects the patient from a pull down menu displayingpatients in the group 610, and enters the data for the Progress Note.The Progress Note follows the quick Progress Note process of FIG. 7including identification and selection of assessment data, patient'sparticipation level, participation quality, “at risk” status, overalltheme of the group and the type of interventions specifically directedtowards the patient with most of the input coming from pull down menus.The problem selected for the individual Progress Note reflects theproblem presented by the patient to the group on that given day and timeof treatment and/or the patient's reaction to the group and itsdynamics.

[0124] For example the group discussion may be about a sense of loss,but an individual patient's reaction to the group might well be anger.Thus, the caregiver would select anger for the individual Progress Note.The information from the pull-down menus will describe the patient'sreaction to the group in general terms, and the expanded note sectionwill document details and possible explanations for the patient'sbehavior from the caregiver's point of view.

[0125] This note taken together with the Group Progress Note provides adetailed picture of the patient's reaction to the complex dynamics ofthe group. Because the time required to produce the Group Progress Noteis divided by the number of participants, the composite time required tocreate a Group Progress Note and an individual Progress Note should beonly slightly more than three to five minutes.

[0126]FIG. 10 shows the process for scheduling appointments forindividual patients. The process begins from the main menu screen 295with the selection of the individual scheduler option 630. Next thecaregiver selects the facility and the patient from pull-down menus 635,then enters the desired schedule data 690. As with the group schedulingdata entry screen 590 as shown in FIG. 9, the invention permitsautomated scheduling of appointments after entering an initial date.

[0127] With item 645, the caregiver decides to schedule another patientor to return to the main menu 650. If the caregiver decides to scheduleanother patient, the process loops around to item 635 so that thecaregiver can select another facility and patient.

[0128]FIG. 11 shows the process for patient enrollment. The processbegins with the main menu screen 295. The caregiver then selects thepatient maintenance option 652, and moves on to entering patientidentification data 655. Patient identification data typically willconsist of entering the patient's name, social security number, date ofbirth, gender and may include the patient's Medicare and Medicaidnumber. Additional, identification data will include date of entry intofacility or treatment, marital status, past hospitalizations, relevantmedical history, and involved family members or friends.

[0129] Next, the caregiver enters the patient's address and the locationof facility where the patient will be housed 660. Although pull-downmenus are used whenever possible throughout the actions represented by655 and 660, most of the data will have to be entered by keyboard. Thecaregiver then moves on to entering the initial assessment data 665.This section makes fill use of pull-down menus to describe the patient'scondition and select the proper diagnostic code. A final step is toenter data on relevant physical issues 670. Here again, pull down menusare used to speed data entry. From this point, the caregiver moves on toitem 675 where a decision is made to return to the main menu 680 or toenroll another patient. If the latter option is chosen, the processloops around to patient maintenance option 652.

[0130] The process of FIG. 12, the caregiver or physician maintenanceoption is similar to the process of FIG. 11. The process starts from themain menu screen 295 with the next step being selection of thecaregiver/physician maintenance option 685. For the enter identificationinformation step 690, most of the information is entered via thekeyboard, but pull-down menus are used where possible to speed up theprocess. The next steps, entering the address 695, access numbers 700,and credentials 705 are made via keyboarding as there is littleopportunity to use pull-down menus. With item 710, the caregiver returnsto the main menu 715 or enters data for a new caregiver/physician 690.

[0131] The processes of FIGS. 11 and 12 are the most keyboard intensivetasks experienced with the invention. However, these are one timeefforts and should not take longer than five to ten minutes per person.Thus, these aspects of the invention will not compromise the overalltime savings offered by the invention.

[0132] The invention may be used in a stand-alone mode or, as shown byFIG. 13, a central server could be used as a database in a local or widearea network application. The main advantage to this approach is therapid compilation of a large historical database. A database compiled bymultiple caregivers becomes an invaluable tool for doing research.

[0133]FIG. 13 shows a central server 800 acting as a database, aworkstation 830 connected via a local area network 825, as well as alaptop computer 810 connected via a modem. Both the workstation and thelaptop would be independent of the server 800 except for downloadingdata at the end of the day or accessing data on an irregular basis.Device 820 represents a terminal in a network environment wherein theterminal is interacting in real time with the server 800. In this caseonly the application is on the terminal. All records are accessed viathe server. The advantage to this is that different users my be granteddifferent access privileges.

[0134] The invention is presently configured as a relational databaseusing a series of tables with common fields to implement the relationalfunctionality. This configuration was selected for ease ofimplementation, flexibility and for the amenability to statistical andother types of inquiries. The product used as a base for the database isMICROSOFT ACCESS®. This is not to say that the invention is tied to therelational database model any more than it is tied to any particularoperating system. That said, the invention works very smoothly andquickly as presently configured.

[0135]FIGS. 14A, B, C, and D show the fields that make up a TreatmentPlan Note report and the sources for the data populating the fields.This report first identifies the patient 827FIG. 14A, displays a historyof past problems 831FIG. 14A, displays symptoms displayed by the patientduring the session being reported on 832FIGS. 14A and 14B, then endswith the Treatment Plan recommendations 833FIGS. 14B, 14C, and 14D. FIG.14A shows the first part of a Treatment Plan Note. The word “patient”802 comes from the Treatment Plan format element 260 FIG. 5 and isalways displayed with a Treatment Plan Note. The accompanying name ofthe patient AAANestor AAATestor 803 comes from the patient master table240 FIG. 4 as does much of the basic patient identification data. Asshown, the patient's social security number 809, gender 804, Medicareand Medicaid numbers 807, date of birth 811, and facility name 806 allcome from the patient master table 240. All these elements are keyed tothe social security number which is referenced by the session ID number812 which comes from the Progress Notes table 195 FIG. 4.

[0136] Thus when a Treatment Plan Note is generated, for a particularsession, the social security number of the patient linked to thatsecession ID number implements the relationship between the two tablesand facilitates the population of the previously discussed patientinformation fields. This also includes the problem DSM-IV Codes 814 and816 that come from the patient master table as well as the attendantverbal descriptions 817 and 818, that come from the problem master table75 FIG. 3.

[0137] The caregiver code 821 and the name of the caregiver 823 comefrom the Progress Note table 195 and the caregiver table 200respectively both of FIG. 4. Thus when this treatment report isgenerated, the caregiver code related to the session ID number from theProgress Note table 195 provides the link to the caregiver name fromtable 200 FIG. 4, thus completing the patient identification section 827FIG. 14A.

[0138] The patient history section 831 receives data from two sources,the patient problem cross-reference table 210 FIG. 4 and the problemtable 75 FIG. 3. Item 210 contains the problem codes, 100.001 item 837being an example, for any problems reported in a Progress Notes. Theseproblems are linked to the patient's social security number, thus areaccessed and displayed when the Treatment Plan Note is generated. Item839 is an example of a verbal description of a problem linked to theproblem codes. These descriptions come from the problem table 75 FIG. 3.

[0139] The information of section 832 FIGS. 14A and 14B comes from theProgress Notes table 195 FIG. 4. This material is inked to this reportwith the session HD code 812. When a problem code is saved for theproblem of the day in the Progress Note table 195, it results in thepopulation of fields 841 and 843. As an aside, if no data were save inthe problem of the day section of the Progress Note table 195, fields841 and 843 would not be populated and the area in the report wouldremain blank As shown in FIG. 14A, item 841 comes from the ProgressNotes Additional Text table 245 FIG. 4 and the attendant problemdescription 843 comes from problem table 75 FIG. 3.

[0140] The caregiver's detailed comments 844 come from the ProgressNotes Expanded Text table 250. Again these items are linked to thesession ID code 812. Boilerplate 846 comes from the Progress Notesextended text table 245 FIG. 4, while the attendant behavioraldefinition 847 comes from the table of behavioral definitions 100 FIG.3. Boilerplate statement 849 concerning related conditions comes fromthe Progress Notes Additional Text table 245 FIG. 4 and the attendantcondition comes from the other related conditions table 165 FIG. 3. Asin earlier cases, the code for item 851 is stored in the Progress Notesrecord 195 FIG. 4 and is linked to the session ID 812.

[0141] Moving to FIG. 14B, the emotional issue boilerplate 851 comesfrom the Progress Note Additional Text table 245, as does the physicalissues boilerplate 852. The emotional issue entry 853 comes from theemotional issue table 160 FIG. 3 while the physical conditiondescription 864 comes from the physical issues table 140 FIG. 3. Theseentries complete item 832, that section of the report dealing thepatient's condition as observed by the caregiver at the time of the 10treatment session.

[0142] Item 833 FIGS. 14B, 14C, and 14D contains the Treatment Plan. Asdescribed earlier, the Treatment Plan is based on the problem observedand noted by the caregiver on the Progress Note. For this report, theproblem of the day is depression 843 FIG. 14A. The first section of theTreatment Plan deals with assessment data. This material is displayed interms of the five dimensions expressed earlier, physical, emotional,intellectual, social and spiritual. The section is headed by boilerplate856 that comes from the Treatment Plan Additional Text element 233 FIG.4. The assessment issues displayed 857, 858, 859, 861, and 862, all ofFIG. 14B, come from the assessment cross reference table item 95 FIG. 3.Two items are described for each assessment issue. As the invention isconfigured presently, these issues are chosen at random from the pool ofdata linked to depression in the assessment cross-reference table 95FIG. 3.

[0143] The rest of the Treatment Plan deals with long term goals, shortterm objectives, therapeutic interventions, and suggested futuretreatment. As descried earlier, the process for populating the datafield for long term goals, short term objectives, and therapeuticinterventions is keyed to the problem of the day, in this casedepression. As is the case for the assessment section above, arandomizing algorithm selects two items from the data pool linked todepression for each category.

[0144] Long term goal boilerplate 863 comes from Treatment PlanAdditional Text 233 FIG. 4 with the attendant data 864 FIG. 14C comingfrom the long-term goal cross-reference table 133 FIG. 3. The nextsection, short term objectives, proceeded by boilerplate 866 which comesfrom Treatment Plan Additional Text 233 FIG. 4, is displayed in the fivedimensions. This data, physical 867, emotional 868, intellectual 869,social 872, and spiritual 871 comes from the short-term objectivecross-reference table 123 FIG. 3. As with the process above arandomizing element pulls two selections from the pool linked to eachdimension from table 123.

[0145] Therapeutic intervention boilerplate 873 comes from the TreatmentPlan Additional Text table 233 FIG. 4. As with the short-termobjectives, two data selections are made for each of the fivedimensions. Physical data 874 FIG. 14C comes from the therapeuticinterventions cross-reference table 127 FIG. 3 as does emotional data876, intellectual data 877, social data 878, and spiritual data 879, allof FIG. 14D. The final section future treatment, is headed by boilerplate 881 from the Progress Notes Additional Text table 245 FIG. 4 withthe attendant data 882 coming from the future treatment table 150 FIG.3.

Ramifications of the Invention

[0146] The ramifications of the invention are both obvious and subtle.It should be obvious from reading the specification that the inventionsaves caregivers a great deal of time and energy. What may not be soobvious is the quality of record keeping and report generation possiblebased on data analysis enabled by the invention. When caregivers mustkeep records without the simulation and aid of the present invention,records often become generic because caregivers do not or cannot taketime to record relevant observations resulting in records for onepatient tending to be similar to another. The focused pull-down menusoffered by the present invention relieve caregivers of generatingdescriptive text while providing them with stimulating multiple choices.

[0147] When a caregiver makes a Progress Note entry using the invention,the effect is that of having a panel of experts presenting variouspossibilities. The caregiver quickly discards those choices that seeminappropriate and selects that which seem reasonable. This multiplechoice approach is swift and much less draining than trying to generatedescriptive material from scratch. Caregivers get tired, discouragedand/or demoralized but the structure of the invention forces a caregiverto generate a sharply focused well articulated record.

[0148] One must also take into account the pressure to reduce treatmentcosts in the mental health field. A course often taken is to use eitherless experienced individuals and or those with lower levels of trainingas caregivers. As an example, a nurse, a social worker, or some othernon-doctoral level treatment professional might replace a doctor as acaregiver. In this environment, the present invention, with its multiplechoice, panel of experts approach is effective for training and can helpcaregivers to become highly effective.

[0149] The automatic combination of a group note linked to an individualnote in a relational database structure is extremely significant.Patients are complex and the ability to draw on the entire record of apatient's experience and reaction to a group setting provides caregiverswith a tool that facilitates defining the real nature of a patient'sproblems. Additionally, the ability to access a complete, detailedpatient history at any time plus the ability to generate Treatment Planalternatives automatically can only enhance a caregiver's ability toprovide more effective patient treatment. Furthermore, because thisinvention is based on quantitative data, even though it has a textualpresentation, it permits unlimited data analysis. These analyses arecustomizable, detailed, flexible and personalized reports determinedsolely by the caregiver's and/or institution's clinical requirements andinterests. Analysis can be performed against any recorded data. Examplesof these reports and data analysis possible include: patients seen bydate range, by location and by caregiver; reports of individual andgroup sessions conducted by caregiver by location; analysis of procedurecodes utilized by caregiver by location; and periodic reports includingall problems addressed in treatment for patients, all physical andemotional issues, all medications, and hospitalizations.

[0150] When all is considered, the present invention simplifies andspeeds up the process of patient record keeping, report generation, dataand trend analysis while aiding caregivers in their search for optimumTreatment Plans. The records accumulated in the invention's historicaldatabase provide a rich source for measuring caregiver and TreatmentPlan effectiveness. The information generated by this invention alsoallows for education and supervision, clinical research and programplanning and advanced cost analysis. In short, not only does the presentinvention increase the efficiency of caregiver record keeping, but alsoit aids them in their attempts to practice more effective therapy.

[0151] Thus the several aforementioned objects and advantages are mosteffectively attained. Although a single preferred embodiment of theinvention has been disclosed and described in detail herein, it shouldbe understood that this invention is in no sense limited thereby and itsscope is to be determined by that of the appended claims. Appendix --Example of Problem List Code Problem  100 Amnesia  200 Anger  300Anorexia and Bulimia Nervosa  400 Antisocial Behavior  500 Anxiety  600Alcohol/Chemical Dependence  700 Alcohol/Chemical Dependence-Relapse 800 Childhood Traumas  900 Chronic Pain 1000 CognitiveDeficits/Confusion 1100 Compulsions 1200 Confusion 1300 Conversions 1400Crisis 1500 Delusions 1600 Denial 1700 Dependency 1800 Depression 1900Dissocation 2000 Eating Disorders 2100 Education Deficits 2200 FamilyConflicts 2300 Female Sexual Dysfunction 2400 Grief/Loss Unresolved 2500Guilt 2600 Hallucinations 2700 Hyperactivity in Children 2800Hypochondriacal Behavior 2900 Impulse Control Disorder 3000 IntimateRelationship Conflicts 3100 Legal Conflicts 3200 Loneliness/Isolation3300 Low Self-Esteem 3400 Male Sexual Dysfunction 3500 Malingering 3600Mania or Hypomania 3700 Manic Behavior 3750 Manipulation 3800 MedicalIssues 3900 Negative Self-Concept 4000 Negativism 4100 Noncompliance4200 Obesity 4300 Obsessions 4400 Paranoid Ideation 4500Passive-Aggressive Behavior 4550 Personality Disorders 4600 Phobias 4700Psychoticism 4800 Rape Trauma Syndrome 4850 Schizophrenia 4900 SexualAbuse 5000 Sleep Disorders 5100 Social Discomfort 5200 Somatization 5300Spiritual Confusion 5400 Suicidal Ideation 5500 Suspiciousness 5600Vocational Stress 5700 Withdrawn Behavior

What is claimed is:
 1. An apparatus for providing historic documentationand prospective treatment advice for a plurality of psychotherapypatients for a psychotherapy provider comprising: means for automatedcollecting and recording of psychotherapy data for the patients, saidpsychotherapy data being in a plurality of categories including historicand prospective information; means for choosing a subset of categoriesfrom said plurality of categories; means for storing a databasecomprising textual data corresponding to a plurality of possiblepsychotherapy data said data including prospective treatment advice;means for referencing into said database by said psychotherapy data insaid subset of categories thereby selecting a portion of said textualdata including prospective treatment advice; means for combining saidportion of said textual data with psychotherapy data including historicdata from said means for automated collecting and recording therebyautomatically generating at least one historical and one prospectivereport.
 2. The apparatus of claim 1 wherein the automated collecting andrecording of patient psychotherapy data and the automated generation ofthe report of claim 1 originates from, and is indexed to, a list ofpossible psychotherapeutic problems.
 3. The apparatus of claim 1 whereinat least one report includes a relatively short form patient report anda relatively long term patient report.
 4. The apparatus of claim 1wherein said at least one report includes prospective treatment advice.5. The apparatus of claim 1 wherein said at least one report includeshistoric information relating to the psychotherapy patient.
 6. Theapparatus of claim 1 wherein said at least one report links thehistorical record of at least two psychotherapy patients.
 7. Theapparatus of claim 1 wherein said database includes a psychological andpsychiatric treatment encyclopedia.
 8. The apparatus of claim 7 furtherincluding means for updating said treatment encyclopedia.
 9. Theapparatus of claim 1 further including means for scheduling therapysessions for individual patients and simultaneously for a group ofpatients.
 10. The apparatus of claim 1 wherein said at least one reportincludes a billing report.
 11. The apparatus of claim 1 wherein saiddatabase is a relational database.
 12. The apparatus of claim 2 whereinsaid list of possible psychotherapeutic problems is derived from medicalliterature and wherein the apparatus further includes means for revisingsaid list of possible psychotherapeutic problems. 13 The apparatus ofclaim 3 wherein generation of at least one report is automated throughmenu selections to the psychotherapy provider.
 14. The apparatus ofclaim 7 wherein said treatment encyclopedia includes: (a) a list ofpossible patient problems (b) a list of possible behavioral definitions(c) a list of possible assessment criteria (d) a list of possible shortterm objectives (e) a list of possible long term goals (f) a list ofpossible therapeutic interventions (g) a list of possible physicalissues (h) a list of possible emotional issues (i) a list of possiblepatient coping mechanisms (j) a list of possible suggested futuretreatments (j) a list of possible related conditions (k) a list ofpossible patient responses
 15. The apparatus of claim 4 wherein saidprospective treatment advice includes at least one set of assessmentdata, at least one short term objective, at least one therapeuticintervention and at least one long term goal for said at least onereport.
 16. The apparatus of claim 1 wherein said historic informationis available to psychotherapy providers at any time during operation ofthe apparatus.
 17. The apparatus of claim 15 wherein said at least oneassessment criteria, said at least one short term objective, said atleast one therapeutic intervention, and said at least one long term goalare defined in terms of at least emotional factors, physical factors,intellectual factors, social factors, and spiritual factors.
 18. Theapparatus of claim 2, wherein entries from said list of possiblepsychotherapy problems can be assigned a severity from a range ofseverities for each psychotherapy patient.
 19. The apparatus of claim 18wherein said assigned severities serve as a weighting factor for theselection of prospective treatment advice.
 20. The apparatus of claim 1wherein said means for selecting said prospective treatment adviceincludes pseudo-random selection.
 21. The apparatus of claim 1 whereinsaid means for selecting said prospective treatment advice includesperiodic selection.
 22. The apparatus of claim 1 wherein the means forautomated collecting and recording of psychotherapy data is linked tosaid database comprising textual data through network means.